To the Editor:
I appreciate Drs. Ginsburg, Leybell and Hoffman's interest in our work. The purpose of our study was to determine whether activated charcoal is more effective in the presence of concurrent anticholinergic activity. Our model, pretreatment with parenteral atropine, was chosen because if there were no effect, additional study would not be needed to address the issue of whether the administration of activated charcoal hours after an anticholinergic overdose might be beneficial. Therefore, only a negative result would have been clinically relevant.
Having said that, I do not agree with Dr. Ginsburg et al.'s concluding statement “activated charcoal should be administered to sick patients who have a potentially lethal overdose.” The key word is “sick.” Over the past decade or so, many have lost sight of the rationale for gastrointestinal decontamination. The intent of this intervention is to prevent the symptoms and signs of poisoning by preventing the absorption of the poison from the gut into the bloodstream. Clearly in sick patients, this has already occurred and thus it is too late for charcoal or other decontamination interventions to have a significant positive impact upon patient outcome. Furthermore, it is the sick patients who are at greatest risk for complications secondary to these interventions.
Remember, activated charcoal and other decontamination procedures are prophylactic rather than treatment interventions.
Milton Tenenbein, M.D.